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Interview with eSanté Luxembourg: Healthcare Terminology Server with EBX5

We got a chance to catch up with the team at eSanté Luxembourg to discuss their healthcare Terminology Server project.

Question: could you tell us a little about eSanté?

Agence eSanté is Luxembourg’s national agency for the exchange and sharing of health information. It was established to enhance the patient’s care coordination, promote interoperability and define a national platform of eHealth services, including an Electronic Health Record named “Dossier de Soins Partagé” (DSP).

Question: Can you describe your most recent EBX5 Project?

To complement our national platform and to support deployment of new services and projects across Europe, eSanté has introduced a service of terminology server, or "Semantic Server".

Question: What was the challenge you are addressing with the eSanté terminology server?

There are numerous parties involved when delivering care to a patient. When these parties exchange health information, it is extremely important that the shared information is understood unambiguously. This can be easy when two teams discuss matters face to face. However, in cases where the communication is asynchronous, or the information processing is automated, we must have mechanisms in place to ensure complete understanding by all parties. The terminology server will participate in fulfilling that need by providing up-to-date reference values upon which each party agreed and will understand in the same way.

Question: How will the terminology server accomplish this?

The terminology server participates in semantic interoperability by managing/governing all the terminologies, nomenclatures, list of values, versions, crosswalks etc. used in the projects of the national eSanté platform.  Examples of reference terminologies include those from HL7 (Health Level 7), International Statistical Classification of Diseases and Related Health Problems (ICD-10), Logical Observation Identifiers Names and Codes (LOINC), Systematized Nomenclature of Medicine-Clinical Terms (SNOMED-CT), among others, in addition to specific list of terms used in Luxembourg. 

The Terminology server is offered as a service to both owners and consumers of these data. The Agency is in charge of its configuration, training and support, while management of terminology remains under the purview of each owning organization and their experts.

Question: how would you characterize the terminology server?

Our terminology server could be described as a business glossary with reference data linking and management. It contains standardized lists of terms, definitions, links to specific domains and tools to describe patient care concepts in a precise way. Consumers and producers of this information will use the terminology server.

Question: can you give us an example code? 

Consider the term “Triglycerides”. It can describe the chemical component itself, or its measurement. Even if we know this context, the measurement can be done in different sample types and using different units. To avoid any confusion, a code can be used to describe with precision what is meant. As an example, in a typical blood test, the measurement of triglycerides could be coded 14927-8, which is a code from the code system LOINC (Logical Observation Identifiers Names and Codes standard).

Question what are some of the other notable capabilities of your terminology server?

Our terminology server enables us to:

  • Organize and visualize (as code tables, hierarchies, graphs) values and relationships in ways that improve ease of use. This is especially important because of the diverse data owners, users and experts,
  • Link concepts from different domains and characterize these relationships (especially cases where there is some correspondence between code sets),
  • Evolve the data over time, recording history, comparing/evaluating changes and updates,
  • Manage permissions to restrict display/access to information to authorized users only,
  • Define workflows that allow participating experts to validate data updates in a governed way, and 
  • Distribute data, or subsets, to external systems using files or web services. 

Question: How is the program going?

Very well! In fact, the Agence eSanté Terminology Server participated in tests conducted during the IHE-Europe Connectathon from April 11th to 15th 2016. 

At the Connectathon, the terminology server demonstrated its flexibility, adapting to various internal representations of the information and providing interfaces to access the data. It was then easy to include it in an interoperable architecture compliant with the IHE SVS (Sharing Value Sets) profile.

We are also working on the customization side: enhancing the models, defining views and relations between domains… to offer a pleasant and productive graphical interface to our users.

List of concepts (represents type of documents):

Direct access to the group containing the concept DT-65003, when looking at the detail of the concept:

This is automatically done when defining the relation between a concept and a group of concepts in the model.

The symmetric part is also directly accessible, here for example the list of concepts inside a group: